Imagine if the healthcare system actually changes, and we move past today’s confusing world where health plans, health systems and life sciences companies have some of their business in fee-for-service and some under value-based, risk sharing arrangements. What would that look like from an IT perspective, especially?
The most important policy lever driving the U.S. toward value-based care is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This bipartisan, bicameral legislation has taken the Center for Medicare and Medicaid Innovation’s (CMMI) investments and incorporated them into payment policy for physicians and other caregivers. In 2017, we are just beginning to see the healthcare delivery system gear up to respond, but by 2025, I expect many more physicians will be in accountable, alternative payment models. At the same time, Medicare, Medicare Advantage, Medicaid, and employer-based health insurance models will likely align around common measures and payment models to deliver high-quality care at a lower cost.
Sarah Thomas
Earlier this year, Deloitte pulled together a multi-stakeholder group to explore what needs to happen for organizations to thrive under MACRA. At that meeting, we heard that technology and data are paramount. Stakeholders will need technology and data solutions to produce and synthesize insights across the delivery system. MACRA will require organizations to use data to report on physicians’ performance, gain insight into what can be done differently, and determine how to improve performance. Collaboration models—between health plans and health systems, and between life sciences companies and the delivery system—will likely arise to share disparate data sources in ways that integrate and harmonize different data sets to make them actionable.
Here are some of the major challenges we face today that I expect healthcare systems, life sciences and technology developers may solve by 2025:
- Existing electronic health records (EHRs) have limited interoperability and can be burdensome for clinicians. As a result, many providers have turned to “add-on” technologies to support their needs.
- Many health systems lack standardization and operations processes for tracking information. Few health systems have figured out how to aggregate all of their data in one place and analyze it so that clinicians have actionable feedback they can use at the point of service.
- Off-the-shelf care coordination platforms might not integrate with existing technology. Integration issues can lead to inefficient workflows for clinical practices. While some EHR systems have add-on modules to support care coordination, such modules can be expensive. They also tend to lack the care-management features needed for true population health management, and are typically focused on patient populations with specific conditions (e.g., diabetes, chronic obstructive pulmonary disease).
- Clinical data registries aren’t integrated. Qualified clinical data registries will likely be an integral reporting tool under MACRA because they let clinicians report their quality, clinical practice improvement, and advancing care information measures. However, some vendors block integration with separate registries or charge additional fees to access them.
Along with these challenges, some basic issues also need to be resolved as providers and patients traverse different health plans, practice arrangements, and locations. These include unique patient identifiers, provider-patient matching and attribution systems, and provider identification.
Beyond solving problems related to today’s information systems, I expect we will see care delivery models leverage technology in a big way. For example, I predict that telemedicine will become commonplace. Other technologies to watch include:
• Artificial intelligence (AI): The ability of computers to think like and complete tasks currently performed by humans with greater speed, accuracy, and lower resource utilization
• Point-of-care (POC) diagnostics: Allow for convenient, timely testing at the point of care (e.g., physician office, ambulance, home, or hospital), resulting in faster, more cohesive patient care
• Virtual reality (VR): Simulated environments that could accelerate behavior change in patients in a way that is safer, more convenient, and more accessible
• Leveraging social media to improve patient experience: Tapping data from social media and online communities to give healthcare organizations the ability to track consumer experience and population health trends in real-time
• Biosensors and trackers: Technology-enabled activity trackers, monitors, and sensors incorporated into clothing, accessories, and devices that allow consumers and clinicians to easily monitor health
• Convenient care: Retail clinics and urgent care centers that provide more convenient and lower-cost care to patients for a number of health issues
We describe how these innovations may promote better value in a recent report.
With the change to incentives under alternative payment models, combined with consumer demands that the system be immediately accessible, I expect health plans, health systems, and life sciences companies to develop applications that allow quick responses to healthcare’s challenges. I’m looking forward to the day when appointments, consultations, and referrals all work seamlessly, and the health system is prepared for me as I interact with it.
Health technology will underlie many aspects of what success will look like as we transform the journey of care, though technology alone is not the whole picture. We are talking about major changes to incentives and new ways of doing business that involve massive change management. I expect all types of stakeholders to innovate and change their business models and embrace technology that helps them do it—for the sake of our healthcare system, and ultimately the patient.
Sarah Thomas is the managing director of the Center for Health Solutions, part of Deloitte LLP’s Life Sciences & Health Care practice. As the leader of the Center, she drives the research agenda to inform stakeholders across the healthcare landscape about key trends and issues facing the industry. Thomas has more than 13 years of government experience and has deep experience in public policy, with a focus on Medicare payment policy.
